Although numerous studies have been conducted previously on the needs of cancer patients at the end of their life, there is a lack of studies focused on older patients with non-oncological complex chronic multipathologies. Examining these needs would help to gain a greater understanding of the profile of this specific population within the palliative care (PC) pathway and how the health and care systems can address them. The aim of this review was to identify the needs influencing PC among older patients with multimorbidities, their relatives or informal caregivers, and the health professionals who provide care for these patients. A scoping literature review guided by the Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist was carried out with literature searched in the Medline, Embase, CINAHL, WoS, Cochrane Library, PsycINFO, and Scopus databases from 2009 to 2022. Eighty-one studies were included, demonstrating a great variety of unaddressed needs for PC among chronic older patients and the complexity in detecting those needs and how to refer them to PC pathways. This review also suggested a scarcity of tools and limited pathways for professionals to satisfy their needs for these patients and their families, who often felt ignored by the system. Substantial changes will be needed in health and care systems at the institutional level, providing more specialized PC environments and systematizing PC processes.

People experiencing homelessness are known to be at risk of disproportionately poor health outcomes and often face barriers in accessing healthcare. Patient navigation (PN) has been identified as a way to address health disparities and engage underserved populations with healthcare services . This scoping review aims to understand how PN models have been utilized with people experiencing homelessness and other comparable populations to date and more specifically identify (a) the defining features, (b) the barriers and facilitators in implementation, and (c) the outcomes associated with PN models. Database searches were conducted in Web of Science, PubMed and SCOPUS on 15th June 2021 and 21 papers, comprising nine reviews and 12 individual studies, were selected. Results indicate that PN has consistently been associated with improvements in a range of health-related outcomes, including timely access to healthcare. While the implementation and measurement of PN varies, a series of consistent features, facilitators and barriers are identified. Interventions to date have utilized a longitudinal approach and non-clinical navigators who share characteristics with the patient, and whose role is facilitatory. To maximize success in future use of PN, further research that focuses on the feasibility of the approach outside the USA is warranted.

Palliative care is an alternative to standard care for gravely ill patients that has demonstrated many clinical benefits in cost-effective interventions. It is expected to grow in demand soon, so it is necessary to detect those patients who may benefit from these programs using a personalised objective criterion at the correct time. Our goal was to develop a responsive and minimalist web application embedding a 1-year mortality explainable predictive model to assess palliative care at bedside consultation. A 1-year mortality predictive model has been trained. We ranked the input variables and evaluated models with an increasing number of variables. We selected the model with the seven most relevant variables. Finally, we created a responsive, minimalist and explainable app to support bedside decision making for older palliative care. The selected variables are age, medication, Charlson, Barthel, urea, RDW-SD and metastatic tumour. The predictive model achieved an AUC ROC of 0.83 [CI: 0.82, 0.84]. A Shapley value graph was used for explainability. The app allows identifying patients in need of palliative care using the bad prognosis criterion, which can be a useful, easy and quick tool to support healthcare professionals in obtaining a fast recommendation in order to allocate health resources efficiently.